1366761058 NPI number — SANCHEZ PRIME CARE PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366761058 NPI number — SANCHEZ PRIME CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANCHEZ PRIME CARE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INTERMONTAIN HEALTHCARE CORE LABORATORY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366761058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1436 W GLENOAKS BLVD
Provider Second Line Business Mailing Address:
STE 193
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91201-1984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-462-5779
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5252 INTERMOUNTAIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84107-5700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-462-5779
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SANCHEZ
Authorized Official First Name:
ILEANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
801-462-5779

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  46D1049154 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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